DISIDA - Welcome to Dep. Nuclear Medicine, KMU

Report
HEPATOBILIARY IMAGING
Presented by
Yang Shiow-wen
11/26/2001
Hepatobiliary Imaging
The function of the biliary tree
and gall bladder
A "HIDA" scan or a "DISIDA"
scan
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Hepatobiliary Imaging
 Performed with a variety of
compounds that share the common
imminodiacetate moiety
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Structures of DISIDA
Blue color: A polar
component (the diacetate)
Red: A lipophilic
component
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Structures of DISIDA
 HIDA

Little used today
 DISIDA

Imaging the gall bladder better when
liver function is poor
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Pathways of DISIDA
 The lipophilic component : binding
to hepatocyte receptors for
bilirubin
 Transported through the same
pathways as bilirubin, except for
conjugation
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IDA-chelated Tc-99m
 A magnification of
two
imminodiacetate
compounds
 Polar components
chelated a Tc-99m
molecule
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Indications
 Acute cholecystitis
 Chronic cholecystitis
 Bile leakage
 Biliary atresia
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Requirements for DISIDA Scan
 Patient preparation: fasted for 4 hours
 Radiotracer: Tc-99m IDA compounds i.v.
 Imaging: serial anterior/lateral views for 60
minutes




Every 5 minutes for 30 minutes
Once at 45 minutes
Once at 1 hour
Delayed views of the gall bladder 2 hours, 4
hours, 6 hours or 24 hours after injection
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Requirements for DISIDA Scan
 Morphine

Injection at one hour to help force the gall bladder to fill
 Water
 CCK

Injection prior to the test to empty the gall bladder
 Suspected chronic cholecystitis

Injection to measure how well the gall bladder empties.
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Normal Study
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Acute Cholecystitis
 The most common indication
 S\S






Nausea, vomiting, fever
Right upper quadrant pain post-prandially
Mild to moderate leukocytosis
Abnormal liver function test
Pain radiates to the back (scapula)
Usually blockage of the cystic duct by a gallstone
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Acute Cholecystitis
 If hepatic scintigraphy reveals adequate
filling of the gallbladder, acute cholecystitis
is effectively excluded.
 Within 30 minutes, the gallbladder fails to
visualize
 Wait for one whole hour
 Differential diagnosis for non-visualization
of the gallbladder

Relaxation of the sphincter of Oddi
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Non-Visualization of Gallbladder
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Non-Visualization of Gallbladder
Negative study– after injection of morphine
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Re-injected DISIDA & Morphine
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Chronic Cholecystitis
 Ultrasound is the primary modality of choice
 S\S



Usually having gall stones
The cystic duct is not blocked
More chronic pain
 Delayed visualization of the gall bladder
 Biliary dyskinesia in response to
administration of CCK
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Bile leaks
 Most appropriate non-invasive imaging technique for
evaluation of bile leaks
 Sensitivity: 87%, Specificity: 100% (2-3 ml of
labeled bile)
 Radiopharmaceutical activity


In an extrahepatic and extraluminal location
More intense with time
 Differentiating intraluminal activity from a leak


Ingestion of water
Standing views in addition to anterior oblique views
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Reflux into Stomach
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Radioactivity in Left Subphrenic Space-I
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Bile Leak Post-cholecystectomy-II
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No Excretion from Liver
 No excretion up to 6
hours
 This pattern is
commonly seen in



Ascending cholangitis
Pancreatitis
Hepatitis
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Pseudo Gallbladder
Radionuclide in C-loop of the Duodenum
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Pseudo Gallbladder
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Pseudo Gallbladder
Disappear after ingestion of water
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Obstruction at Ampulla
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Irregular Uptake in Liver-I
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Metastatic Deposits in Liver-II
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References
 http://www.vh.org/Providers/Lectures/IRO
CH/BiliaryNucs/BiliaryNucs.html (Virtual
Hospital)
 Chapter 38, Hepatobiliary Imaging, Darlene
Fink-Bennett, P759-770
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The End
Thank for Your Attention !
11/26/2001

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